Transitional Care for Older Adults: Demonstration of the Role of a Partnership Payvider

A payvider organization provides both payer and provider services and has been linked to administrative and patient cost reduction by improving right-sized utilization of patient care services. A geriatric-focused transitional program was offered to patients covered under a value-based care risk contract formed by the payvider relationship of an integrated health system. This article describes a prospective study comparing utilization and cost metrics of patients enrolled in the transitional care program with the goal of analyzing utilization of services to better understand patient behavior patterns and care needs after hospital admission and consecutive enrollment in the program. Patients enrolled in the program incurred lower costs in all categories but home health care than the reference population. The cost avoidance achieved during the study period was estimated to be over $1.1 million. Individuals participating in the program had similar emergency department visit rates during the 90- and 180-days following the hospital as the reference population but had significantly lower inpatient readmissions (7.8% vs. 15.4%) even with a higher average readmission risk score (66.8 vs. 65.5). The implementation of the transitional care program led to reduced costs and more efficient utilization of services than those not enrolled in the program. The payvider relationship allows systems to think proactively about new initiatives and programs that will better serve their communities, especially when identifying groups with high projected costs and service utilization. Patients benefit from the assurance that the services they are receiving are covered by their insurer and their trusted organization.